In 2008, Dr. Michael Williams, MD, became the CEO of Hill Country Memorial Hospital in Fredericksburg, Texas, after serving on its board for five years and after serving several years as the lead anesthesiologist at the hospital. Dr. Williams assumed the role with the goal to improve the quality of care and ensure the sustainability of the 86-bed hospital. As a practicing anesthesiologist, Dr. Williams earned his MBA from Duke University and more recently a master's in healthcare management from Harvard, providing him a foundation for understanding the business side of healthcare. He also serves as an executive vice president for EmCare's Anesthesia Care Now division, where he is involved with strategy and leadership development. Here discusses the challenges of running a rural hospital and opportunities for improving how care is delivered.
Question: Tell me a bit about your background. What were you doing before you were named CEO of Hill Country Memorial in 2008?
Dr. Michael Williams: I am an anesthesiologist and ran an anesthesia and critical care practice in Dallas for several years. In 1995, my family and I moved to Fredericksburg for a small town environment. In Dallas, I started my practice from the ground up and grew it to 12 providers. The practice I started here on my own grew to eight providers. I always enjoyed the managing partner role and the opportunity to join vision and strategy for a group of people. I certainly never set out to be a hospital CEO — though I had anticipated some leadership role within medical management — but I fell in love with the hospital and the people here. They're very genuine and hardworking, and I felt they needed leadership for the future. When the board offered me the interim CEO role in 2008, I took it on with plans to do my very best to keep the hospital moving in the right direction. After three months, the board had started to see changes in the right direction and offered me the permanent position. At that point in my career, I had been doing anesthesia for some time and felt it was a good time in my career for a change.
Q: In a previous article that appeared in Becker's Hospital Review, you mentioned the importance of being a "disruptor" that encourages a culture of change. Do you think that's a required role of all hospital and health system CEOs?
MW: I'm not sure it's a role every CEO needs to take on, but there has to be some leader [in the organization] that is comfortable with change and disruption. In healthcare today, we are technologically advanced, but in terms of a management structure, we're relatively antiquated. Those of us that are disruptors believe government can't provide solutions; we have to be creative and innovative and use the resources we have to drive that innovation. One way to do that is to bring about the right kind of disruptive innovation. I think a disruptor is an important role, but I realize not everybody can be or wants to be a disruptor. Others can fill the important role of "first followers." These are the people that really get movement for an idea and can make the change a reality.
Q: How, specifically, does the culture of Hill Country Memorial support disruptive change?
MW: We start off with our mission, which is providing remarkable care for our families, friends and neighbors — always. It's the antithesis of just being good or just being average. Historically, the focus [in healthcare delivery] has been on the provider and not the patient. For example, fee-for-service benefits the hospital and the providers. We work to reorder those priorities. We're always asking, "How do we reorient the priorities and focus first on patients, families and the employees we serve?" We push ourselves to find ways to provide remarkable care that sets the benchmark for everyone else.
Q: What other qualities or characteristics do you think hospital leaders need to be successful?
MW: First, [leaders] have to be a diplomat but at the same time a provocateur. You have to take the risk you'll be the lone nut talking about new ideas. I'd also love to see more hospital leaders trained outside traditional routes and go through more formal business training. It's very important to focus on healthcare as a business and how you deliver value to your stakeholders. You have to run [healthcare organizations] on business principles. Third, leaders should be comfortable with transparency about results, including financial and quality measures, and comfortable sharing them both externally and internally. Fourth, leaders should be intolerant of mediocrity. The days are over where you could just be good and exist. Last, people in a leadership position need to understand that leadership is about how you service those around you. People that truly lead understand that, and leaders can be at any level of the organization. Leadership is not defined by position, but by the hearts, hands, and heads of all employees who aspire to lead. Hospital leaders must develop the people they serve, seek innovative solutions, and seek partnerships with all the stakeholder groups.
Q: How has the role of hospital/health system leaders changed since the introduction of healthcare reform?
MW: I've narrowed it down to five fairly common problematic pathways leaders take in response to reform, all of which are reactive compared to proactive. The first is being extremely risk averse. These people are those that "fall on the ball," meaning instead of running or passing the ball, they just fall on it. The second response is to always chase the latest reimbursement model, whatever that may be, and not taking enough time to assess it, which I don't think is a long-term strategy. Third, some are just digging in and hoping this will pass. Fourth, a few are denying change will actually happen. And fifth, a few are running out to put a sale sign up or looking for a merger. Instead of reacting, I'm hoping we'll see more leaders step up and be proactive. In a time of adversity and confusion, there are tremendous opportunities if leaders are willing to take a risk and look at them. Health care as an industry must change. We must minimize waste and variation in the entire care continuum. Also, we must redefine the full continuum of care using disruptive innovation and reinvent who we are as providers.
One thing we're finding though is that rural hospitals, like ours, are almost completely left out of the reform dialogue. There are about 70 million Americans served by small and rural hospitals and we need to figure out how to get more attention for them. Hill Country Memorial recently started an initiative to bring together like-minded rural hospitals in Texas in a group we're calling "Texas CARES." We come together to work on things, such as driving up patient satisfaction and driving down preventable harm to zero. It's a grassroots effort with no government support tied to it, and it's been very gratifying. We just recently held our first meeting and all 20 hospitals we invited to participate signed up. Rural and small hospitals, with 100 beds or less, have options besides the five I mentioned earlier. As Henry Ford once said, “Coming together is a beginning, keeping together is progress, working together is success.”
Q: What is the biggest challenge you believe you'll face as a healthcare leader in the next 2-3 years?
MW: I think one of the biggest challenges will be trying to bring the right disruptive innovation to a fairly static system. Our hospital is focused on delivering remarkable value to patients, their families and the people on our team. While we've seen really big gains, the financial rewards aren't there to keep us sustaining it. We hope to get attention from payors to reward higher quality care at a lower costs. Why should we wait for the government to pull it off? Why can't we come together as business people and figure it out?
I'd also like to see changing priorities in healthcare, a change in a mindset of a system that's so engrained in certain behaviors. Currently the system primarily rewards physicians and hospitals, and there has been less focus on what the impact is for the patient and his or her family. It keenly troubles me personally to see a family who goes through an adverse event cornered off and not spoken to by those who are there to care for them. Invite the family and patients in, have an open and transparent conversation, and ask them to help [the hospital] get better. They're often hugely interested in being a part of that. We want patients, and families on our improvement team. They must not be the silent stakeholders in health care.
Q: What advice would you give to other healthcare leaders?
MW: The biggest piece of advice I would give: Don't accept the status quo. We can change healthcare for the better. A good place for us to start is with facts — admitting that a major issue with our system is how we hurt patients [through medical errors]. Let's work to fix that. Let's work to drive value higher, lower costs on a very large scale, make care safer, more efficient, and reduce preventable harm. Let's work to provide remarkable health care for rural and urban Americans — all Americans.
Related Articles Featuring Healthcare Leaders:
Delivering Compassionate Care as the Key to Hospital Success: Q&A With Jack Lahidjani, President of Calif.'s Mission Community Hospital
Hospital Leadership is a Culture, Not a Person: Q&A With LifePoint Hospitals CEO Bill Carpenter
Question: Tell me a bit about your background. What were you doing before you were named CEO of Hill Country Memorial in 2008?
Dr. Michael Williams: I am an anesthesiologist and ran an anesthesia and critical care practice in Dallas for several years. In 1995, my family and I moved to Fredericksburg for a small town environment. In Dallas, I started my practice from the ground up and grew it to 12 providers. The practice I started here on my own grew to eight providers. I always enjoyed the managing partner role and the opportunity to join vision and strategy for a group of people. I certainly never set out to be a hospital CEO — though I had anticipated some leadership role within medical management — but I fell in love with the hospital and the people here. They're very genuine and hardworking, and I felt they needed leadership for the future. When the board offered me the interim CEO role in 2008, I took it on with plans to do my very best to keep the hospital moving in the right direction. After three months, the board had started to see changes in the right direction and offered me the permanent position. At that point in my career, I had been doing anesthesia for some time and felt it was a good time in my career for a change.Q: In a previous article that appeared in Becker's Hospital Review, you mentioned the importance of being a "disruptor" that encourages a culture of change. Do you think that's a required role of all hospital and health system CEOs?
MW: I'm not sure it's a role every CEO needs to take on, but there has to be some leader [in the organization] that is comfortable with change and disruption. In healthcare today, we are technologically advanced, but in terms of a management structure, we're relatively antiquated. Those of us that are disruptors believe government can't provide solutions; we have to be creative and innovative and use the resources we have to drive that innovation. One way to do that is to bring about the right kind of disruptive innovation. I think a disruptor is an important role, but I realize not everybody can be or wants to be a disruptor. Others can fill the important role of "first followers." These are the people that really get movement for an idea and can make the change a reality.
Q: How, specifically, does the culture of Hill Country Memorial support disruptive change?
MW: We start off with our mission, which is providing remarkable care for our families, friends and neighbors — always. It's the antithesis of just being good or just being average. Historically, the focus [in healthcare delivery] has been on the provider and not the patient. For example, fee-for-service benefits the hospital and the providers. We work to reorder those priorities. We're always asking, "How do we reorient the priorities and focus first on patients, families and the employees we serve?" We push ourselves to find ways to provide remarkable care that sets the benchmark for everyone else.
Q: What other qualities or characteristics do you think hospital leaders need to be successful?
MW: First, [leaders] have to be a diplomat but at the same time a provocateur. You have to take the risk you'll be the lone nut talking about new ideas. I'd also love to see more hospital leaders trained outside traditional routes and go through more formal business training. It's very important to focus on healthcare as a business and how you deliver value to your stakeholders. You have to run [healthcare organizations] on business principles. Third, leaders should be comfortable with transparency about results, including financial and quality measures, and comfortable sharing them both externally and internally. Fourth, leaders should be intolerant of mediocrity. The days are over where you could just be good and exist. Last, people in a leadership position need to understand that leadership is about how you service those around you. People that truly lead understand that, and leaders can be at any level of the organization. Leadership is not defined by position, but by the hearts, hands, and heads of all employees who aspire to lead. Hospital leaders must develop the people they serve, seek innovative solutions, and seek partnerships with all the stakeholder groups.
Q: How has the role of hospital/health system leaders changed since the introduction of healthcare reform?
MW: I've narrowed it down to five fairly common problematic pathways leaders take in response to reform, all of which are reactive compared to proactive. The first is being extremely risk averse. These people are those that "fall on the ball," meaning instead of running or passing the ball, they just fall on it. The second response is to always chase the latest reimbursement model, whatever that may be, and not taking enough time to assess it, which I don't think is a long-term strategy. Third, some are just digging in and hoping this will pass. Fourth, a few are denying change will actually happen. And fifth, a few are running out to put a sale sign up or looking for a merger. Instead of reacting, I'm hoping we'll see more leaders step up and be proactive. In a time of adversity and confusion, there are tremendous opportunities if leaders are willing to take a risk and look at them. Health care as an industry must change. We must minimize waste and variation in the entire care continuum. Also, we must redefine the full continuum of care using disruptive innovation and reinvent who we are as providers.
One thing we're finding though is that rural hospitals, like ours, are almost completely left out of the reform dialogue. There are about 70 million Americans served by small and rural hospitals and we need to figure out how to get more attention for them. Hill Country Memorial recently started an initiative to bring together like-minded rural hospitals in Texas in a group we're calling "Texas CARES." We come together to work on things, such as driving up patient satisfaction and driving down preventable harm to zero. It's a grassroots effort with no government support tied to it, and it's been very gratifying. We just recently held our first meeting and all 20 hospitals we invited to participate signed up. Rural and small hospitals, with 100 beds or less, have options besides the five I mentioned earlier. As Henry Ford once said, “Coming together is a beginning, keeping together is progress, working together is success.”
Q: What is the biggest challenge you believe you'll face as a healthcare leader in the next 2-3 years?
MW: I think one of the biggest challenges will be trying to bring the right disruptive innovation to a fairly static system. Our hospital is focused on delivering remarkable value to patients, their families and the people on our team. While we've seen really big gains, the financial rewards aren't there to keep us sustaining it. We hope to get attention from payors to reward higher quality care at a lower costs. Why should we wait for the government to pull it off? Why can't we come together as business people and figure it out?
I'd also like to see changing priorities in healthcare, a change in a mindset of a system that's so engrained in certain behaviors. Currently the system primarily rewards physicians and hospitals, and there has been less focus on what the impact is for the patient and his or her family. It keenly troubles me personally to see a family who goes through an adverse event cornered off and not spoken to by those who are there to care for them. Invite the family and patients in, have an open and transparent conversation, and ask them to help [the hospital] get better. They're often hugely interested in being a part of that. We want patients, and families on our improvement team. They must not be the silent stakeholders in health care.
Q: What advice would you give to other healthcare leaders?
MW: The biggest piece of advice I would give: Don't accept the status quo. We can change healthcare for the better. A good place for us to start is with facts — admitting that a major issue with our system is how we hurt patients [through medical errors]. Let's work to fix that. Let's work to drive value higher, lower costs on a very large scale, make care safer, more efficient, and reduce preventable harm. Let's work to provide remarkable health care for rural and urban Americans — all Americans.
Related Articles Featuring Healthcare Leaders:
Delivering Compassionate Care as the Key to Hospital Success: Q&A With Jack Lahidjani, President of Calif.'s Mission Community Hospital
Hospital Leadership is a Culture, Not a Person: Q&A With LifePoint Hospitals CEO Bill Carpenter